Multicentre study comparing ab-interno canaloplasty and trabecular micro-bypass stent in primary open-angle glaucoma

Eye (Lond). 2026 Apr 28. doi: 10.1038/s41433-026-04483-4. Online ahead of print.

ABSTRACT

PURPOSE: To compare canaloplasty and trabecular micro-bypass surgery outcomes in primary open-angle glaucoma (POAG).

METHODS: Ambispective study using data from the International Glaucoma Surgery Registry (IGSR) to evaluate mild-to-moderate POAG patients who underwent iTrack ab-interno canaloplasty (Nova Eye Medical, USA) (prospective cohort) or iStent trabecular micro-bypass implantation (Glaukos, USA) (retrospective cohort), with or without concomitant phacoemulsification, and ≥12 months of follow-up. Primary outcomes were intraocular pressure (IOP), medication usage, and surgical success as defined by the American Academy of Ophthalmology (2024).

RESULTS: The study included 339 eyes (iStent: n = 115; iTrack: n = 224) of which ≥94% underwent concomitant phacoemulsification (iStent: n = 109, iTrack: n = 210). There were nonsignificant differences in baseline IOP (p = 0.417) and medications (p = 0.741) between groups. At last follow-up, mean IOP (mmHg) and medication usage decreased from 17.3 ± 4.2 and 2.0 ± 1.1 at baseline to 14.2 ± 3.5 and 1.3 ± 1.1 in the iStent group (p < 0.001; mean follow-up: 27.2 ± 14.5 months), and from 16.9 ± 5.0 and 2.0 ± 1.1 at baseline to 14.3 ± 3.4 and 1.1 ± 1.3 in the iTrack group (p < 0.001; mean follow-up: 20.3 ± 7.7 months). Both groups showed no significant differences in reduction of IOP (p = 0.422) and medications (p = 0.211). More eyes were medication-free in the iTrack group (42% vs 29%; p = 0.029). Success was achieved in 61% of eyes in both groups (p = 1.000). Postoperatively, both groups demonstrated infrequent and self-limited complications, no sight-threatening events, and low reoperation rates.

CONCLUSION: In POAG, iTrack canaloplasty and iStent implantation showed no statistically significant differences in effectiveness outcomes. Both procedures had favourable safety profiles with limited additional glaucoma surgeries. More canaloplasty eyes were medication-free compared to stent eyes.

PMID:42049871 | DOI:10.1038/s41433-026-04483-4